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Comment by CapstanRoller | Hacker News Reader

>I feel great and my brain seems to be functioning as well as when I was in my 20’s

>but my untreated ADHD seems to be getting worse.

I had very similar results after taking ketamine for treatment-resistant depression. It eliminated all my compulsive tendencies for getting cheap dopamine hits (food, doomscrolling, etc), reset my tolerance to everything (caffeine, ADHD meds, alcohol), and made my ADHD worse while improving throughput and ability to Get Shit Done.

I wonder if they affect the same parts of the brain in a roundabout way? Ketamine is also used to treat addiction (opioids, primarily).

Do you experience any anhedonia while using Mounjaro? Did your overall pleasure response get blunted?

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Ketamine treatments help people, because ketamine is a dissociative drug. It makes you not feel your suffering, also makes you not feel the positive feelings. That’s why you’re not eg doomscrolling. It doesn’t feel good for you anymore. If you’re not getting treatments regularly, you will be back to suffering in a few months likely. In my opinion, there are better alternatives and more effective treatments than living a life of disassociation.

this is not true at all. the dissociative effects only last a few hours. the clinical benefit is because ketamine stimulates neurogenesis in the mPFC and hippocampus, restoring plasticity lost in depressed patients.

don't make unsubstantiated leaps :-)

Yes the immediate effects last for a few hours. I didn’t say otherwise. The current scientific literature paints a mixed picture of ketamine. While it can stimulate neurogenesis, there is a definite potential for neurotoxicity. Not to mention that there are no long term studies out there. There are countless people reporting being anhedonic after treatments. Only a few people have been reported to not relapse before 24 weeks.

I’m not making unsubstantiated claims. Don’t accuse me of that, because you don’t like my answer.

>Only a few people have been reported to not relapse before 24 weeks.

So what? Ketamine is a treatment, not a cure.

Would you apply the same logic to insulin for T1 diabetes?

You are comparing apples to oranges my friend.

How so?

We don't know of any cure for depression, but with ketamine we have an effective rapid treatment.

Ketamine has a great therapeutic range, a well-understood side effect profile, and can bring a patient back from the brink of suicide in a matter of hours. It's also incredibly inexpensive to produce, on par with aspirin. Why shouldn't we use it?

That’s the thing. We don’t know a cure, but we know of people who were cured. We just don’t really know how or why, scientifically speaking. And as far as I know there was never someone getting cured from t1 diabetes. That’s what I meant by apples and oranges.

Ketamine or suffering & death? Ketamine no question. I agree, but it’s not so black and white how you may perceive it. It might be ketamine or death for you, I don’t know. For me it was certainly. So sorry, if it is for you now. I’m not telling you it’s bad or that you shouldn’t do it. Do whatever you think is the best for you. I went through all of that and found other methods of treatment actually effective of solving the root causes of my suffering and not just the symptoms. Meditation, somatic experiencing and mdma therapy[1] are the main methods I found the most effective, in no particular order.

I’m not looking to argue about your choice of treatment. If you want to share your experience or hear mine, give me a way to contact you. Have a good night/day. [1]https://www.nature.com/articles/s41591-021-01336-3

your link is for PTSD, not depression. no studies have come out so far showing MDMA has any effectiveness in depression. the proposed mechanism for PTSD involves serotonin release leading to heightened extinction of fear memory in the hippocampus and amygdala. no reason to believe necessarily this will help with depression.

you sure there is no reason? MDD can be a subtype of PTSD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518698/

Ketamine saved my life, but I also know people who say MDMA saved their life (and I believe it).

In my case, MDMA would not have been the appropriate treatment.

All of the things we are discussing have value and a role in mental health care. It doesn't have to be a contest.

That's not what your comment said at all though.

>Neurotoxicity

unclear. on the onehand, unpublished studies in gorillas show no lesions. on the other, retroactive studies of heavy polydrug abusers show lesions. not super high-quality evidence either way. there's also rat studies showing lesions, but rats are unusually sensitive to neurotoxicity from dissociatives. they get similar lesions from nitrous oxide while humans get no such thing. honestly the potential bladder toxicity is more concerning imo.

>relapse rate

still much better success rates than SSRIs.

not saying ketamine is perfect --- would be better to have a purpose-built drug, and a lot of the clinics are kind of scummy and charge exorbitant prices. but this + non-psychedelic 5ht2a plastinogens are the most promising things to come out of depression research in the past 45 years.

This isn't true. I am not dissociated when not actively undergoing the treatment.

If anything, the after-effects of ketamine treatment alleviate my lifelong dissociation and other symptoms depression and PTSD. Something about the induced dissociation "wraps around" and snaps people back into fully being present.

Have you ever had ketamine treatment? Where are you getting these conclusions?

Yes I did have two treatments. After the first treatment I really liked it and I thought I had my life back. All my debilitating symptoms were gone. Weeks after the second treatment I noticed that my depression and trauma is not gone. It just made me not constantly aware of it, if that makes sense. I was not clinically dissociated as well, just dissociated from the things that caused my suffering. I didn’t think that was a healthy way of living, so I stopped getting treatments. Luckily I found forms of treatments to actually heal after that. I’m incredibly glad I did.

Ketamine didn’t heal me, my perspective just changed, which can be valuable though.

> Ketamine didn’t heal me, my perspective just changed

I thought that was the entire point of the treatment. Is that not the case?

I don’t know it might be. I went in with the mindset of wanting it to help me end my suffering, not change my perspective. I think that’s the case for most people.

Your perspective is the suffering though, unless I am missing something? The whole thing with trauma response and all the various things that come from that is that different things have different effects on different people, because their perspectives are different. The treatments that work (CBT, EMDR, etc) also rely on changing your perspective of the event or your response to it.

> I did have two treatments

> Weeks after the second treatment ... I stopped getting treatments

This sounds like an unusual, very sparse schedule. Most ketamine treatment routines have many more than two doses, and nothing resembling multi-week intervals between doses at the start.

My wife has undergone ketamine treatment, and as part of it, I read up on the literature. Typical ramp-up schedules (like hers was) would be one or twice per week for one or two months, and then less frequently until you stop or go into "as-needed" maintenance dosing.

I'm glad you found other things that worked for you, but what you describe doesn't sound like a normal course of ketamine treatment.

Ketamine is no better than placebo for depression: https://www.science.org/content/article/ketamine-no-better-p...

This is not peer reviewed, looked at only 40 people, and has dubious methodology.

> anhedonia

Possibly slightly, but not life impacting.

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